Sunday, February 27, 2011


A 10 year old came in by EMS in with a severe asthma exacerbation. Lets call him Man-Of-Da-House. He was accompanied by his 7 year old sister. They had been home alone all day, and little sis called 911 when Man-Of-Da-House was having a really hard time breathing.

It took 3 hours to find mom. She strolled in the ER like it was no big deal. No she was not at work during the ordeal. The kids looked 5 years younger than their actual age. I think b/c they are probably neglected.

Man-Of-Da-House wasn't getting much better, so we had to transfer him to a children's hospital. Most moms will do whatever to stay with their child when they are being admitted and definitely transferred. This one didn't...she said she was going home to change clothes. Poor little Man-Of-Da-House was transferred in an ambulance to a different hospital all alone. He looked terrified

I was livid. I was a Man-Of-Da-House myself....but at least my mom gave a shit.

-ER Doc

Thursday, February 24, 2011


I admitted this guy to the hospital a few nights ago. I asked how he ended up there, and he started with, "Well you see, I'm a very religious person..."
This is almost always a bad sign. Nothing against religion, but it can take marginally crazy people and push them right over the edge. I can't tell you how many times I've heard "God is talking to me" or "The devil is in my head". Why doesn't anyone ever hear Uncle Leo? or a furry little rabbit? or a GI Joe? I digress.

This guy has been smoking weed and PCP, every other day, for 13 years. Except for the 6+ years he was in prison for his 7 felonies. A couple weeks ago, he was partying with some buddies, then decided to go into a bedroom to pray, while high. "I was talking real fast, real stupid, Doc, and I said some bad things. I blasphemed God. I felt really bad. I started thinking about what I should do about it. Then I remembered the passage that said 'God said you should cut off what offends him.'"

So a few days later, he was partying at a friend's house again (he's always at a friend's house because he has no house), and he busted out a steak knife and cut his tongue off. Not all of it, just the distal 1/3. Then, his caring friend, who had a bunch of warrants, dragged the patient into the front yard of the house next door with his tongue in his pocket, and called 911. Which was nice, because what would a guy with no tongue tell the dispatcher? "Ahhhhhh thit! I cut oth tha thip of my thucking thung!"

By the time I talked to him, his tongue was sutured back on. He was happy he did it. "My relationship with God is more calm now. I wonder what my future will be like with this speech problem. But I did the right thing. I shouldn't have blasphemed."

I tried to rationalize with him about other Bible teachings, like how we were created in God's image. If that's true, wouldn't cutting of your tongue be equal to cutting of God's tongue? "I never heard that before." Funny since he's very religious (refer to paragraph one.)

I think the passage is Matthew 5:30

"And if thy right hand offend thee, cut it off and cast it from thee; for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell."

Taken in context, it seems most likely Jesus is speaking in parable or even sarcasm.

Think about it the next time some Bible thumpers gives you a literal, concrete translation of a Bible passage.

Sunday school is over. Drugs are bad.

-Psych Doc

Sunday, February 20, 2011

The Invincible Ironman

Have you ever seen the patient who will not die? He who cannot be killed, despite every self-inflicted effort to do so? In the medicine ER, they may be called Gomers. Here is the story of the ultimate psych gomer, who I have christened Ironman.

Ironman has been coming to my hospital since my first year of residency. It started out as suicidal ideation. It progressed to overdosing on psych meds. He would get hospitalized on a med floor, transferred to psych, then sent to a nursing home/group home/state hospital. Rinse and repeat, multiple times. Then he started overdosing on a certain medication. A lot of it. I won't say the name, because I don't want to give anyone ideas. But they were real overdoses, with really high levels, that would have killed some people and given end-organ damage to lots more. He has done this multiple times, and the above sequence kept repeating itself again.

More recently, he started swallowing things. Non-food things. Batteries, pins, pens, paper clips. Even a tree branch. Again, any one of these could have been bad, but somehow he survives. The thing is, he IS NOT trying to kill himself! He really just wants to be institutionalized for the rest of his life. Lots of people have the same wish (believe that), but they usually lie to doctors and sometimes succeed. Ironman doesn't lie (at least about his "suicide" attempts), but despite his serious attempts, he continues to thrive.

What I have told you so far covers only his visits to my hospital. I know he has been to every other hospital in town several times. A few weeks ago, this text exchange happened.

ER Doc: You know a guy named Ironman? Says he was discharged from your hospital and overdosed on (that bad med discussed above).

Psych Doc: I'm surprised u never saw him before. Whatever he said, he prolly did it.

ER Doc: He looks pretty bad.

Then last week:

ER Doc: Ironman is back. Swallowed a tab off a coke can.

Unfortunately, I don't think my literary skills have relayed the scope of this guy's pathology. Oh, wait, here are some more examples.

1. He has ripped out IVs. Lots of them. Not because of agitation or delirium, but because he was mad at me for not admitting him to the psych unit.

2. Yes...we are getting burnt out on consulting this guy. Surgery consults all the time for swallowed foreign body, and my attendings won't even go assess for suicidality.

3. If he finds a new med student or doctor he's never met, he will claim that some psych med gives him priapism. I used to punish med students by having them check that one out for me. The best report I ever received from a med student was "half-mast, at best".

4. Once, he was particularly upset on our inpatient unit. He was trying to fight somebody, so he was placed in a seclusion room. He then started eating his own feces. I guess he thought it hurt us more than it hurt him. Cops were called in to help restrain him, and he grabbed onto an officer's apple bag so hard, he had to go home sick. Then Ironman was discharged to jail. At least I didn't have to see him for 3 months.

This is the story of the worst case of a personality disorder I have ever seen.

This is narcissism, borderline, antisocial, dependent rolled into one hot mess.

This is the man who will survive the apocalypse.

This is the legend of Ironman.

-Psych Doc

Thursday, February 17, 2011

Bed Rest

A 24 year old patient that was 6 weeks pregnant came to the ER for a doctors excuse. What was the excuse for you might ask???

Patient: "I was on bed rest for my entire pregnancy last time. So I need a note for my job saying I can be on bed rest for the next 9 months."

Me: "Uhhhhh.....are you serious?"

Patient: "Of course, can I have the note."

Me: "I have never heard of anyone being on bed rest for their entire pregnancy. Were you high risk? What was the problem?"

Patient: "Are you calling me a liar? Are you going to give me a note or what."

Me: "Well you know if you were on bed rest that it needs to be managed by an OB/GYN, not by a random ER Doc you are never going to see again. And the fact that you can't give me some answers raises some red flags. So no, I am not giving you a note and you need to see an OB/GYN for your pregnancy."

Patient: "So.....can I be off for 9 months?"

Me: "Please leave now."

ER Doc

Tuesday, February 15, 2011

Valentines Day In The ER

Real pic from the ER last night. A nurse got flowers from her boyfriend. No she had to use a urinal. Classic.

ER Doc

Saturday, February 12, 2011

Tough On The Outside

A 37 year old male was taken to our trauma center for "car vs motorcycle." He was the person riding the motorcycle.

He had no complaints and didn't want to come to the hospital. He looked like a tough guy. EMS convinced him to come in since he wasn't wearing a helmet. He was about 6'2", red hair, and wearing all camo gear.

Part of going to a trauma center means you get stripped from head to toe while in the trauma bay. So the nurses took off his boots and cut off all his thick camo clothing....

And to our surprise, this tough guy had freshly shaven legs and a tiny pink and yellow woman's thong on! It was cold outside, but saying he had a little shrinkage was an understatement. It looked like he had a little acorn in his thong!

You definitely had to be there....but it was greatness.

ER Doc

Wednesday, February 9, 2011

Just Gross

A tall, burly paramedic student went to do an EKG on a 78 year old woman with chest pain.....

To do so, he had to life one of her saggy, 78 year old breasts out of the way to place a lead.

Old Lady: "Oh yeah...that feels good. Keep that up young man!"

Paramedic Student: "Uh, excuse me."

Old Lady: "You heard me, don't be ashamed. It's been 3 years since I have gotten sum!"

The student finished the ekg as the lady lay there in ecstasy. He denies any further stimulation to the patient.

-ER Doc

Thursday, February 3, 2011

The Incredible Shrinking Member?

About 6 weeks ago, a 50-ish male presented to me for his first ever visit to a psychiatrist. He wouldn't tell the nurse why he needed to talk to a doctor. That's usually a warning that something very violent or funny is going to happen soon. Luckily, it was the latter.

He said to me, right off the bat, "Doc, my d!(k is shrinking! When I went to prison, I had a solid 9 inches. When I got out, the best I can do is 4 inches!" He went on to explain how he's been out of the pen for 3 years and hasn't been with his wife because he was too embarrassed. He bragged about his prowess prior to being incarcerated. On and on about the shrinking worm. He was clearly not psychotic, but did have some problems with irritability and moodiness. Also, he had the following things in his history that could contribute to erectile issues: 20 years of meth use, one MI, and type 2 diabetes. At that time, he had no insight into how those things could have affected him.

He said the reason he came in was because his PCP thought he was crazy. I emailed the PCP and ask that she please refer him to urology (why she couldn't figure that out, I don't know). I saw him about 6 weeks after the initial visit. This time, he admitted, "I think all those years of doing speed are what did this to me." I asked him if he was involved in NA or AA. Of course not, but he was thinking about getting active.
I told him he needs to go to NA and tell all the guys there to put down the pipe or your manhood could pay the price. He should go on a scared straight campaign to local high schools. He admitted that would be a good idea. Nothing should motivate a guy more than this predicament.
And this blog post is my anti-drug statement of the day.

-Psych Doc

Tuesday, February 1, 2011


I ran across this book in the grocery store.... "What Your Doctor May Not Tell You About Fibromyalgia." I have a few ideas......

1) That it is a fake disease.

2) That you are histrionic/borderline personality disorder at the least, and are bat shit crazy at the worst.

3) That it is most commonly treated with antidepressants. Hmmm....

4) That your doctor hates you and you annoy the shit out of him.

5) To NEVER tell your ER doctor or nurse that you have fibromyalgia, because you will not be taken seriously.

6) That we think all your multiple drug allergies are bull shit, all your other chronic pain syndromes are bull shit, and we are not surprised that you have multiple divorces because it is too taxing for a man to be around you.
  • That's right. I am assuming it is a disease of women....because it is. Over 80% of people "affected" are woman. Hmmm.....
7) If you are a man with fibromyalgia (I have never met one), then you are complete pussy.

I welcome any others you can think of in the comment section. Also, I am fully prepared for the line of fire I will receive for this.

-ER Doc